Optimal Timing of Elective Laparoscopic Cholecystectomy After Endoscopic Clearance of Choledocholithiasis in the Patients With Choledochocystolithiasis
Sang-Woo Cha*1, Seung Yeon Na1, Anna Kim1, Sae Hee Kim1, Hyang Ie Lee1, Yun Jung Lee1, Hyeon Woong Yang1, Sung Hee Jung1, Joo Seung Park2
1Division of Gastroenterology, Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Republic of Korea; 2Department of Surgery, Eulji University College of Medicine, Eulji University Hospital, Deajeon, Republic of Korea
Background/Aim: Elective laparoscopic cholecystectomy (LC) is common after endoscopic clearance of choledocholithiasis for patients with choledochocystolithiasis accompanied by acute cholecystitis. However, the optimal timing in those patients remains uncertain. The aim of this study was to identify whether the time interval between two procedures can affect the course of LC in terms of conversion rate or complications. Patients/Methods: Among the patients with choledochocystolithiasis accompanied by acute cholecystitis from January 2005 to June 2010, those who underwent LC after endoscopic bile duct stone removal by endoscopic retrograde cholangiopancreatography (ERCP) (n=358) were studied retrospectively, comparing the course of LC in four time interval groups; LC ≤7 days, 8-14 days, 15-21 days and ≥22 days after ERCP. Primary outcomes are postoperative complication rates, conversion rates into open surgery and occurrence rates of preoperative biliary events. Results: Three hundred fifty eight patients (mean age, 60 years) were analyzed (group 1, n= 42; group 2, n= 112; group 3, n= 105; group 4, n=99). Conversion rates into open surgery, postoperative complications of LC and preoperative biliary events were 5% (18 of 358), 3% (11 of 358), and 2% (8 of 358) and there was no significant difference between four groups.Multivariate analysis showed both age older than 80 years (95% confidence interval, 1.03-17.29; P = .045) and history of previous operation (95% confidence interval, 1.82-14.27; P = .002) to be independent risk factors for conversion to open sugery. The endoscopic sphincterotomy may be a factor in the lower conversion rates (95% confidence interval, 0.01-0.34; P= .003). Among the patients who underwent percutaneous transhepatic gallbladder drainage (PTGBD) had significantly more postoperative complications of LC (95% confidence interval, 1.07-9.77; P = .008). There were no independent risk factors for the occurrence of preoperative biliary events. Conclusions: The time interval between endoscopic clearance of choledocholithiasis and LC did not affect the latter procedure in terms of complications or conversion to open surgery. However, the conversion rate was lower in patients who underwent endoscopic sphinctertomy and postoperative complication rate was higher in patients who received PTGBD.
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